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C ough and Hemoptysis

C ough and Hemoptysis. Levy Liran , M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel. Definition. ‘Explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree free of secretions and foreign material.’.

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C ough and Hemoptysis

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  1. Cough and Hemoptysis Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel

  2. Definition ‘Explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree free of secretions and foreign material.’

  3. Complications of cough Chest and abdominal wall soreness Exhaustion Urinary incontinence Cough syncope Hernias, Uterine prolapse Cough fractures

  4. Cough Reflex

  5. Etiology Post nasal drip Laryngitis, tumor, whooping cough, croup Tracheitis Bronchitis, COPD, Asthma, Bronchial Carcinoma TB, Pneumonia, Bronchiectasis, Pulmonary Oedema, Interstitial Fibrosis

  6. Differential diagnosis Acute- < 3 weeks URTI- common cold, sinusitis, pertussis Aspiration Inhalation of chemical/smoke Subacute- 3 to 8 weeks Post infectious (pertussis, post viral) Chronic- > 8 weeks Metabolic/Mulad Inflammatoryasthma,eosinophilic bronchitis, COPD, bronchiectasis, PND, ILD, pneumoconiosis Infectious TB, mycobacteria, fungus, atypical bacteria Neoplastic mass involving tracheo-bronchial tree Drugs ACE inhibitors Vascullar pulmonary congestion, PE Toxin/ChemicalGERD, smoking

  7. Approach to chronic cough • History • Circumstances surrounding onset of cough • Sputum – color, smell • Type • Hemoptysis • Duration • Variation- posture, time • Precipitating factors & what makes it better • Associated symptoms

  8. Approach to chronic cough Physical Examonation Full cardio-pulmonary examination: Inspection Palpation Percussion Auscultation Investigations: Chest X Ray Sputum cytology & microbiology Pumonary Function Tests (PFT) High Resolution CT (HRCT) Fibreoptic bronchoscopy Echo PH metria Swallow study Sinus imaging

  9. Management of cough > 8 weeks Cough > 8 weeks Smoking ACEI Stop Cough persists CXR Normal Abnormal Evaluate with: HRCT Sputum testing Bronchoscopy Echo PH metria Swallow study Sinus imaging Post nasal drip Asthma Eosinophilic bronchitis GERD

  10. Treatment • Acute- < 3 weeks • or • Subacute- 3 to 8 weeks 90% of diagnoses of chronic cough with normal CXR Chronic- > 8 weeks Fail to respond merits further investigation

  11. Hemoptysis Expectoration of blood from the respiratory tract Massive hemoptysis- 100-600ml per day

  12. Etiology Tracheo bronchial Pulmonary parenchyma Primary Vascular Miscellaneous

  13. Anatomy Bronchial artery Pulmonary vein Pulmonary artery

  14. Differential diagnosis • Most common cause is infection of medium-sized airways: • Western world  viral/bacterial • World wide  TB

  15. Aproach to patient with hemoptysis

  16. Treatment Blood streaking or small amounts of blood Establish the diagnosis Follow up Massive Hemoptysis *Proper positioning *Endotracheal intubation (single lung) *Balloon Catheter *Bronchoscopy with laser phototherapy/ electrocautery *Bronchial artery embolization *Surgery

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